Healthcare

Member
Management 

Empower Members by Partnering with an Innovative Healthcare BPO

We know that navigating the healthcare system can be difficult and frustrating. By partnering with Everise, you can have access to advanced approaches and technologies that help reduce friction in the member journey.

Comprehensive member experiences: powered by people and technology, curated by experts.

Today member expectations are at an all-time high, and a single negative encounter can quickly reverberate online. Experience and empathy are the cornerstones of surpassing these expectations. At Everise, we are experts in the health insurance space with deep experience in the industry. We design a workforce model tailored to your needs and offer single tier through multi-tiered support levels so that you get the depth of support your members deserve.  

Foster Trust and Accessibility in Healthcare Insurance

Healthcare insurance is a complex landscape and can often overwhelm or frustrate members. We tailor our services to the unique needs of your member base, lifting the burden of daily customer service from your shoulders and enabling you to focus on delivering quality services. Our agents work to demystify co-pay structures, authorization levels, covered entities, and covered services, ensuring members are well-informed and that there are no surprises.  

Scaled Staffing Optimized for Seasonal Changes 

We’ve designed our services around the ability to swiftly ramp up our staff to handle spikes using a mix of flex-shoring and remote working capabilities, ensuring minimal call abandonment rates. We’ve also tailored a tiered agent seniority structure to match your members’ needs, directing complex queries to our seasoned agents.  

Deliver Unmatched Member Experiences Consistently 

Member satisfaction is critical to success. When a member reaches out, they want their concern to be solved quickly and efficiently. As a People-Centric Healthcare BPO, we provide members with an optimal experience founded in empathy. This can include receiving a welcome call upon joining, explaining their unique benefits and underlining the maximum potential of their health plan. However, our commitment doesn’t stop there. We contact at-risk members and conduct health risk assessments to determine if referrals to specialists are needed. Our agents expertly manage both in-network and out-of-network insurance claims, offering tailored care to each member. Amid unforeseen situations like claim denials or unexpected charges, we guide members through appeals and grievances, instilling trust and reducing stress.

Build An Innovative Long-Term Partnership

We are a healthcare BPO that enables transformation in the contact center by understanding your unique market approach and applying our proven mix of people, process and technology to create the ideal solution. Our members’ experience technology ecosystem is crafted through in-depth industry knowledge of the healthcare industry’s unique pain points. Partnering with Everise ensures you take advantage of cost-saving opportunities and better member experiences.

Are your current contact center partners delivering value to you and your members?

Compare us. In the Healthcare BPO environment, “value” is measured in quality of service. Everise’s performance on statistics such as NPS, CSAT, CTM (Complaints to Medicare), and FCR (First Contact Resolution) exceed client goals and outperform other suppliers.

80+ NPS

compared to industry standard of 27

0 CTM

in just 60-days post-implementation

10%

reduction in repeat calls

Enable Frictionless Omnichannel Member Experiences

As member demographics span various generations, embracing new digital support channels is crucial while preserving a robust base of agents ready to answer the call when needed. Our award-winning, omnichannel member experience solutions span voice, email, chat, social media, chatbots, and more, providing you with a single Voice of the Customer for all your channels.

Our Member Engagement Capabilities

Claims status and research
Benefits Eligibility
Physician & Hospital lookup
Member Education
Appeals and grievances

Disease-specific proactive outreach
Welcome outreach
Product Orientation
General customer service (co-pay, ID card, etc.)
Transportation coordination

Use Data to Fine-Tune Members’ Journeys

We look closely at critical metrics such as Average Talk Time (ATT) and Average Handle Time (AHT), which measure how efficiently our agents handle calls. Lower ATT and AHT correlate strongly with higher member satisfaction scores. Using our trademarked approach, Systematic Insights, our team uncovers critical member pain points and NPS obstacles through the use of advanced data analytics. We use these insights to identify process improvements that drive more efficient interactions that generate higher long-term satisfaction.

Cost Effectively Meeting Members’ Needs Through Right shoring

With a skilled and experienced team, you can meet your members’ needs from anywhere in the world. Everise currently delivers member management services from the United States, Guatemala, Colombia, and the Philippines. If you are unsure how to migrate offshore, we’ve helped multiple US health insurance clients move from a 100% onshore model to service delivery across the globe. With the saving realized, they have been able to reinvest in better products and services for their members.

Member Management